ABSTRACTTeam work and communication among healthcare professionals are essential to a positive patient experience in the pediatric emergency department (ED)(1). A recent lack of team communication in the local pediatric ED has led to an increase in parent complaints and decrease in patient satisfaction scores. Through the use of the Care Team Model (CTM), care providers can work together in a standardized workflow with teamwork and communication, to hear a patient’s story one time and manage care together to improve the quality of the visit and the patient experience(2). Staff education to the CTM process, with a strong sustainability plan is necessary to improve teamwork and communication in the local pediatric ED(3).

PICOT QUESTIONFor staff working in the ED (P), how does team communication education (I) compared to no team communication education (C) impact parents’ perceptions of their experience in the ED as measured by ED HCAHP scores (O) within 12 months (T)?

LITERATURE REVIEWA thorough review of the literature demonstrates that teamwork and communication are influences of the patient experience(2). The common themes focus on patient/parent communication preferences, communication of the care team, benefits and challenges of team communication, standardized communication tools, and staff education.

• Patient/Parent communication preferences

• Care team communication

• Benefits and challenges of team communication

• Standardized communication tools

• Staff education

Improving the Patient Experience

through Enhancing Healthcare Team

Communication at Primary

Children's Hospital Emergency

DepartmentAmelia Back, MSN, RN

CTM: a process that includes any provider and nurse evaluating the patient together, where the patient shares the “story” once, and care is managed by the team together

CTM Education and Implementation Plan:

• Staff meetings for all disciplines

• Mandatory skills days

• Leadership rounding in the department

• A CTM education video will be developed and become a part of new ED nurse orientation

• Learning will be evaluated through a checklist of the CTM process after watching the video

LEWINS’S THEORY OF PLANNED CHANGE (TPC)Commonly known as Lewin’s 3-stage process of unfreeze, change, and refreeze; The TPC provides a framework to manage change in an effective and productive way(5). Current ED team communication is ineffective, the CTM will be implemented, and ongoing education and use of CTM will be sustained as the new ED communication practice.

• Unfreeze – Ineffective ED team communication

• Change – Implementation of the CTM process for team communication

• Refreeze – CTM sustainability and ongoing education

CONCLUSIONSEducation and implementation of the CTM process in the pediatric ED is a unique and collaborative method for improving teamwork and communication between care providers. Research suggests that improving communication between care providers and the patient/family improves the patient experience(2). Strategic teamwork and communication provide the foundation to a patient focused culture and workflow(2). Educating to the CTM process allows for consistent methods of staff learning and implementation which promotes sustainability and standardization for new employees to the identified workflow and desired culture(3).

REFERENCES1. Byczkowski, T. L., Fitzgerald, M., Kennebeck, S., Vaughn, L., Myers, K.,

Kachelmeyer, A., & Trimm, N. (2013). A comprehensive view of parental satisfaction with pediatric emergency department visits. Annals of Emergency Medicine, 62(4), 340-350. https://doi.org/10.1016/j.annemergmed.2013.04.025

2. Dudley, N., Ackerman, A., Brown, K. M., Snow, S., K. (2015). Patient-and family-centered care of children in the emergency department. American Academy of Pediatrics, 135, e255-e272. https://doi.org/10.1542/peds.2014-3424

3. Eddy, K., Jordan, Z., & Stephenson, M. (2016). Health professionals’ experience of teamwork education in acute hospital settings: A systematic review of qualitative literature. Joanna Briggs Institute of Systematic Reviews and Implementation Reports, 96-136. https://doi.org/10.11124/JBISRIR-2016-1843

4. Cameron, K. A., Engel, K. G., McCarthy, D. M., Buckley, B. A., Kollar, L. M., Dolan, S. M., ... Adams, J. G. (2010). Examining emergency department communication through a staff-based participatory research method: identifying barriers and solutions to meaningful change. Annals of Emergency Medicine, 56(6), 614-622. https://doi.org/10.1016/j.annemergmed.2010.03.017

5. Mind Tools. (2018). Lewin’s change management model. Retrieved from https://www.mindtools.com/pages/article/newPPM_94.

6. *Note images of and by author

PROJECT METHODOLOGYImproving teamwork and communication in a local pediatric ED through use of CTM is important to effectively improve the patient experience and work environment. The methodology for improving team communication in the local pediatric ED will include education and practice implementation of the CTM workflow. Content development and education tools for the CTM will be created by the ED NICE team. The NICE team members include physicians, a nurse practitioner (NP), and several nurses. Effective communication between ED staff through the use of the CTM process may improve patient/parent experience as reflected by improved ED HCAHPS scores and a decrease in parent complaints about poor communication.

CTM Evaluation Plan

Leading Indicators: • Paper ticket completed for each CTM

episode for first month after implementation

• Parent survey with question about teamwork for first month after implementation

Lagging Indicator:• Improvement in ED HCAHPS scores

questions (nurse communication, physician communication, and how well staff worked together) evaluated monthly for 12 months post implementation

• Parent survey 3 months post implementation